SpectraCell Blog

Most people assume that standard cholesterol testing offers an adequate assessment of heart disease risk. If you, like many, have never heard of a lipoprotein profile test, you may be surprised to learn that this test assesses an important risk factor called Lipoprotein(a) or Lp(a) (“lipoprotein little a”). Influenced by genetics and strongly linked to heart disease and blood clotting problems, this risk factor unfortunately is NOT part of routine cholesterol tests or standard lipid panels. In fact, lipoprotein(a) is so strongly linked to heart disease, that it is one of the four lipid-related risk factors cited by the National Institutes of Health National Cholesterol Education Program (NCEP) as worthy of monitoring. Unfortunately, Lp(a) has been notoriously difficult to treat pharmacologically, as statins have shown little efficacy in lowering Lp(a) levels.

Why is Lp(a) so harmful?Evidence suggests that Lp(a) may serve as the link between thrombosis and atherosclerosis. Recent clinical studies have implicated Lp(a) as a risk factor for blood clots whether or not atherosclerosis is present. Because Lp(a) is a small, very dense LDL, it can easily penetrate the arterial lining, become oxidized and build plaque, thus contributing to atherosclerosis independent of its thrombotic potential.

How is high Lp(a) treated?

In a recent double-blind, placebo-controlled trial, patients with elevated cholesterol and elevated Lp(a) were divided into two groups, each with 29 people: Group 1 received a statin only and Group 2 received the same statin plus 2 grams/day of L-carnitine, a supplement that plays a key role in fatty acid transport within cells. After 12 weeks, the group receiving only a statin showed about a 7% reduction in Lp(a), but the group receiving the L-carnitine in conjunction with the statin demonstrated over 19% reduction in Lp(a) levels. Authors suggest that co-administration of L-carnitine (whose primary function is fatty acid metabolism), may enhance efforts to lower Lp(a) compared to using a statin alone.

Although heredity plays a large role in the levels of Lp(a), treatment with niacin has also been found to lower levels of Lp(a).

Is carnitine the answer for male infertility?A group of men (n=96) who had been diagnosed as infertile for at least 18 months were given the following nutritional formulation daily for four months: L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, zinc, vitamin C, vitamin B12 and folic acid (see abstract for exact dosages). At the end of the study, sperm motility improved and 16 of the patients had achieved pregnancy. The authors concluded that carnitine may be the key component of the supplement cocktail for improving sperm quality. (Italian Archives of Urology and Andrology, September 2012)

LINK to ABSTRACT Prospective open-label study on the efficacy and tolerability of a combination of nutritional supplements in primary infertile patients with idiopathic astenoteratozoospermia.

Vitamin D helps leg ulcers healIn this double-blind, placebo controlled trial, 26 patients with leg ulcers were given either placebo or 50,000 IU vitamin D weekly for two months. Leg ulcer size, blood levels of vitamin D and pain was measured before and after the two month trial. In the vitamin D group, leg ulcers were reduced in size by 28% while the placebo group had only a 9% reduction in ulcer size. The authors stated “there was a trend toward better healing in those with vitamin D reposition.” (Journal of Brazilian College of Surgeons, October 2012)

Complexity of methylation reactions gains insightThis review emphasizes how methyl donor nutrients such as choline, folic acid and methionine interact and how consumption (via supplement or food) of one can have sparing effect s on another – such as choline’s sparing effect on methionine, for example. (Current Opinion in Clinical Nutrition and Metabolic Care, January 2013)

The metabolic marker homocysteine has gained attention as an area of treatment for various conditions ranging from cardiovascular disease to general skin health. Homocysteine as a marker for disease risk modification has been seen as a factor not ideally suited for pharmacological intervention, but more so for nutrient supplementation. This makes sense as the methylation pathways, of which homocysteine is a marker for, are dependent on the nutrients folate, B12, B6 and SAMe. Moreover, being able to realize the interplay between these nutrients is critical when it comes to repletion so as to make sure that nutrient deficiencies are not obscured or induced by therapeutic repletion dosages. This states the necessity of having a valid nutrient testing method.

SpectraCell’s micronutrient assessment allows for targeted intervention with regards to homocysteine, a marker identifiable on the Lipoprotein particle profile. By being able to see the individual micronutrients, various pieces of the metabolic pathway picture can be put together. This allows the clinician to know exactly which treatment options to reach for to have the greatest impact on homocysteine. Of course, all of this is based on the notion that homocysteine is an inflammatory marker than responds mostly to nutrients. While nutrients are indeed a very critical part of homocysteine lowering therapy, they are hardly the entire story.

More recent studies have shown that while homocysteine will respond to those nutrients that can act as methyl donors, it will also respond to more classical anti-inflammatories such as omega 3 fatty acids and plant based extracts. This underscores the point that in some ways homocysteine acts similar to other inflammatory markers in responding to more classical non-pharmacologic anti-inflammatories. But how do you know if either of these are an option for homocysteine lowering? For this information, we transition back to those tests offered by SpectraCell. The micronutrient test offers a novel marker known as Spectrox which allows for the assessment of total antioxidant function. As plant based phytonutrients are known for their potent anti-inflammatory properties, a lower Spectrox marker, indicating lower antioxidant / anti-inflammatory capacity, would confirm that usng plant based antioxidants would be a viable treatment option. One such example of this in when homocysteine is showing increased clotting potential. Introduction of resveratrol would have multiple effects in this scenario including elevation of total antioxidant function and the Spectrox marker, lower clotting potential and reduction of homocysteine. Similar effects can be seen with omega 3 fatty acids which collective studies have shown will lower homocysteine. A useful tool to determine omega 3 status is the Omega 3 Index, a test which can guide treatment intervention.

Then there are the tough cases where homocysteine levels are excessively high compared to the normal ranges. At this point, consideration should be given to the potential for genetic variants for folate metabolism, specifically with regards to MTHFR (Methylenetetrahydrofolate Reductase). Those patients that are showing excessively high levels of homocysteine are likely to be carriers of the gene variants, thus warranting MTHFR genotyping.

The more we have come to know about homocysteine, the more we understand that looking at the past day status quo of treatment, while valid, is not comprehensive. Moreover, it is insufficient to fully determine the appropriate intervention to recommend as homocysteine lowering therapy.

Arland Hill, DC, MPH, DACBN - Complete Care Chiropractic and Wellness

For more information about Dr. Hill, please visit his website or his blog. Or, contact him at 281-557-7200.

The LDL phenotype and size result has been removed from our most recent LPP™ report due to misinterpretation and lack of therapeutic guidance.

LDL phenotype is an outdated designation to identify a large LDL type from a small LDL type. LDL phenotype was used in the past because accurate data on individual LDL subgroups was not available or inaccurate. Today the LPP™ test gives accurate information on large-buoyant and small-dense LDL subgroups and this is much more specific for treatment and risk assessment than phenotype.

Phenotype is one result that represents an average density or size for all LDL subgroups and is useful if the value of LDL is high but is very misleading if LDL is low. In fact when LDL is low or reduced in treatment the end result is often a more smalldense LDL profile with a type B phenotype. Therapy such as statin drugs remove mostly large-buoyant LDL leaving the treated patient with a much reduced LDL particle number that is comprised of a higher percentage of small-dense LDL. Since overall particle numbers are reduced this is a positive result for the patient.

A better method for LDL risk assessment and treatment is to use the number of LDL III and IV particles as a guide. These values give the exact number of type B or the most atherogenic LDL particles regardless of the phenotype designation.

The qualitative phenotype result can be determined in an alternate way rather than from the mean LDL density by looking at the dense LDL III and LDL IV subgroups. If both LDL III and LDL IV are “normal” then the phenotype is “Type A”. If one or both LDL III or LDL IV is “borderline” then the phenotype is “Type I” and if one or both LDL III or LDL IV is “high” then the phenotype is “Type B”.

SpectraCell Laboratories has officially been granted a license to provide its Lipoprotein Particle Profile™ (LPP™) test, which assesses cardiovascular risk, to New York state physicians and patients. The recently patented LPP™ test has been commercially available to the other 49 states since 2006.

SpectraCell began the process of acquiring a licensure in 2008 with an application submission the state of New York. The laboratory underwent an initial inspection by the New York State Department of Health in late 2009 followed by extensive documentation validating the LPP™ procedure, which is standard protocol required of all diagnostic laboratories. A final inspection in December 2010 concluded the evidentiary process, proving the LPP™ technology is valid, accurate and reproducible.

“Acquiring our New York license allows us to serve the largest metropolitan area in the country,” states Dr. Fred Crawford, PhD, VP of Operations and Laboratory Director at SpectraCell Labs. “In fact, many physicians in the state of New York have wanted to implement the LPP™ test in their practice but were unable to do so until now. Plus, we recently streamlined our LPP™ report using feedback from existing LPP™ clients, making it easier than ever for physicians to translate LPP™ results into clinical decisions.”

New York represents a large market for laboratory testing. According to a CNN report, approximately 40,000 physicians practice within a 30 mile radius of New York City, in contrast to a national average of about 8000 physicians for other American cities.

After visiting the laboratory and reviewing the testing protocol, Dr. Robert Rej, Director of Chemistry for the State of New York Department of Health recommended the permit be approved for SpectraCell’s LPP™ testing. The license also allows SpectraCell to add FDA approved chemistry procedures to New York clients. Their first addition will be LpPLA2 testing (lipoprotein-associated phospholipase A2) which measures a specific enzyme linked to thrombosis (blood clots), indicating a higher risk of heart attack or stroke.

Just a few months ago, SpectraCell Laboratories was awarded a patent on their Lipoprotein Particle Profile™ (LPP™) test, which measures both the size and number of lipoproteins rather than the cholesterol contained within them. In recent years, more doctors have seen standard cholesterol tests label a patient “normal” when in reality their risk for heart disease is quite high.

In fact, The National Cholesterol Education Program (NCEP) acknowledges that 50% of people that have heart attacks have “normal” cholesterol – that is, cholesterol below 200 mg/dL. The LPP™ test allows physicians to stratify risk more accurately, thus prescribing therapies that will be the most effective, depending on their patients’specific lipid profile.

NCEP recognizes four risk factors that are not measured with routine cholesterol testing but are all measured by the LPP™ test:

RLP – (remnant lipoprotein) more easily converted into arterial plaque than other lipoproteins

Lp(a) – a dangerous lipoprotein that contributes to clot formation

HDL2b – a type of HDL that indicates how well cholesterol is being cleared from your system

We are excited to introduce our new report for the Lipoprotein Particle Profile™. We believe the changes that have been made will make the report easier to read and will facilitate your assessment of risk and the selection of patient specific treatment programs.

Many physicians continue to utilize the traditional cholesterol or lipid panel for guidance in the selection of an appropriate treatment strategy. Although we believe that the treatment is better determined by the application of the results from HDL and LDL subgroups and their particle numbers, the traditional lipid panel continues to be used for risk assessment and we are therefore including it in our report.

Elimination of CEQ

Many physicians and their patients found the practice of reporting lipoprotein test results in terms of cholesterol equivalents confusing. Therefore, we are eliminating this concept from our report.

Addition of ApoB, non-HDL cholesterol and non-HDL particle numbers

A value for non-HDL cholesterol has been included since it is likely to be the new NCEP ATP IV target of therapy when the guidelines are released later this year. Additionally we have added Apolipoprotein B and non-HDL particle numbers which were the focus of the Consensus Statement of the American College of Cardiology and the American Diabetes Association for better risk assessment. Individual variability in the triglyceride and cholesterol composition of the lipoprotein subgroups can make particle numbers more meaningful in risk assessment.

Other report changes include:

• Lp(a) results have been moved to the Risk Modification section.

• The reporting units for hs-CRP have been changed from mg/dL to mg/L which changes the reference range to 0.00 – 3.00 mg/L.

• The LDL mean size/phenotype result has been deleted as this result can often be misleading as a result of variances in the total LDL result.

• The Apo B reference range has been changed to 40 – 100 mg/dL.

• The Apo A1 reference range has been changed to 115 – 224 mg/dL. This test is not a part of the LPP™ Basic or Plus panels, it must be ordered separately.

Houston, TX- January 28, 2011. SpectraCell Laboratories has recently been awarded a patent on their Lipoprotein Particle Profile™ (LPP™) test which is used to measure cardiovascular risk. The LPP™ has been commercially available since 2006, and is a type of advanced cholesterol test that measures lipoprotein subgroups. The LPP™ gives more accurate estimation of cardiovascular risk compared to a routine cholesterol test.

The patent was awarded for use of a “Method for Analyzing Blood for Lipoprotein Components.” Specifically, the LPP™ test utilizes a patented analytical ultracentrifugation method for separating lipoprotein subclasses. This separation method for LPP™ originated at Texas A & M University and was further developed by Dr. Jan Troup, the inventor of LPP™ technology, who is also a member of SpectraCell's scientific staff.

“The LPP™ generally doesn’t cost the patient any more than a standard cholesterol test, but it gives the doctor much more relevant and accurate information.” states Dr. Jan Troup, PhD, and Director of Lipid Science for SpectraCell Laboratories. “Different lipoproteins respond differently to therapy, whether it is statins, fish oils or niacin, for example. The LPP™ enables the doctor to treat appropriately.”

In recent years, the medical community has discovered that, beyond “standard” cholesterol tests, an independent factor for heart disease can be determined by measuring the density and number of lipoprotein particles, to which cholesterol is attached. Patients with a normal cholesterol value, but abnormal particle sizes or numbers, can be at serious risk for cardiovascular disease.

In fact, The National Cholesterol Education Program (NCEP) acknowledges that 50% of people that have heart attacks have “normal” cholesterol – that is, cholesterol below 200 mg/dL. NCEP recognizes four risk factors that are not measured with routine cholesterol testing but are all measured by the LPP™ test:

The main reason to know NCEP risk factors are that specific lipoproteins respond to specific therapies very differently. The LPP™ is part of the trend toward more individualized medicine. The LPP™ test, which is done on a fasting blood sample, is usually covered by insurance. Results typically take 3-5 days.

There has been a lot of talk about cholesterol recently in the news. This is largely due to one startling statistic to which most people are unaware: 50% of people who have heart attacks have "normal" cholesterol. What??? Stated differently, that means that half of all heart attack victims may have had a routine cholesterol test done on the very day they had the heart attack and felt fine because their cholesterol (by routine testing standards) was "normal." So, why do so many practitioners use a diagnostic test that is only 50% accurate?

The reason is simple: that's what doctors have been using for years, decades really. But now there is more accurate testing available. Basically, it's an evolution of the former, out-dated cholesterol testing. Knowing your HDL and LDL - the "good" and "bad" cholesterol is only the beginning. SpectraCell’s LPP (Lipoprotein Particle Profile) test goes much, much further.

Here is the basic scenario of heart disease: When our blood vessels are "scratched," or injured, plaque builds up in our arteries to repair the injury, sort of like a scab on the inside of the blood vessel, causing reduced blood flow. Since plaque buildup is our bodies' response to injury of the blood vessels, reducing the injury to our arteries is key.

That's where cholesterol comes in. Actually, cholesterol is good. Everyone needs it. In fact, it protects us in many ways. Cholesterol is actually a response to vascular injury - not the cause of it. Cholesterol is really not the culprit. Lipoproteins are. Lipoproteins are what "scratch" or "burrow" into our arteries causing injury. They are actually tiny balls in our blood that carry the cholesterol, our vascular scapegoat. Lipoproteins are what do the damage, not the cholesterol inside them. In fact, a lipoprotein can be almost empty of cholesterol and it can still wreak havoc on our arteries, depending on its size and characteristics. Cholesterol is really just along for the ride. Lipoproteins, at least the dangerous ones, are the real villain.

There are different sizes of lipoproteins. In general, bigger is better. Here's why: Larger, fluffier LDL particles cannot lodge into your arteries (which is an injury to the artery) as easily as the smaller LDL particles can. Less injury to the artery means less plaque formation and clearer, more pliable blood vessels - a good thing. So it is imperative to understand what kind of LDL (low density lipoproteins) you have floating around in your blood. There are some that are extraordinarily dangerous and some that are completely benign.

For example, RLP (also called remnant lipoprotein) has been cited by the government as a very high risk factor for heart disease. But statins, which lower LDL, will do nothing to help your RLP. Omega 3 fatty acids effectively lower RLP. So, if you don't know what kind of lipoproteins you have, you're shooting in the dark in terms of what treatments you should take.

Here's another example: Lp(a) - so dangerous that it is sometimes called the widowmaker - is lowered by the simple vitamin B3 (also called niacin). Again, you may be taking statins or fish oil pills, but they won't affect Lp(a). You can see why measuring just plain old LDL is certainly not enough. That is why 50% of the people who have fatal heart attacks have "normal" cholesterol - they are not getting the right cholesterol/ lipoprotein test done.

Here's the best part: SpectraCell's LPP test costs about the same as an outdated cholesterol test and it is also usually covered by insurance. Why wouldn't you want an LPP done?

SpectraCell's Preferred Payment Options offer an upfront co-pay with no remaining balance due from the patient. In addition, we are pleased to offer additional promotional options (valid through December 31, 2010). Pricing applies to all Preferred Pay Patients with private insurance coverage.

Lipoprotein Particle Profile™ Plus - advanced technology which accurately measures both the size/density and number of lipoprotein particles. Measuring the lipoprotein subgroups is the only way to accurately assess cardiovascular risk - according to the National Cholesterol Education Program (NCEP).

Comprehensive Cardiovascular Risk Assessment - $100

Lipoprotein Particle Profile™ Plus - advanced technology which accurately measures both the size/density and number of lipoprotein particles. Measuring the lipoprotein subgroups is the only way to accurately assess cardiovascular risk - according to the National Cholesterol Education Program (NCEP).

HS-Omega-3 Index® - measures percentage of EPA and DHA levels. In addition to determining a patient's risk for Sudden Cardiac Death, there are potential benefits of omega-3 oils in a wide range of medical conditions.